Background

In many market settings individuals are encouraged to switch health care providers as a means of ensuring more competition. Switching may have a potentially undesirable side effect of increasing unnecessary treatment. Focusing on the most common source of medical radiation (dental X-rays), the purpose of this study was to assess whether, upon switching dentist, X-ray exposure increases depending on the type of provider payment.

Methods

The analysis used longitudinal data from 2005 to 2016 covering a 5% random sample of the Scottish adult population covered by the National Health Service (NHS). Multiple fixed-effects panel regression analyses were employed to determine the correlation of provider remuneration with patients’ likelihood of receiving an X-ray upon switching to a new dentist other things equal. A broad set of covariates including a patient’s copayment status was controlled for.

Results

Upon switching to a dentist who was paid fee-for-service, patients had a by 9.6%-points (95% CI 7.4–11.8%) higher probability of receiving an X-ray, compared to switching to a salaried dentist. Results were robust when accounting for patient exemption status, as well as unobserved patient and dentist characteristics.

Conclusions

In comparison to staying with the same dentist, patients may be exposed to substantially more X-rays upon switching to a dentist who is paid fee-for-service. There may need to be better guidance and regulation to protect the health of those who have to switch provider due to moving and greater caution in advocating voluntary switching.

中文翻译：

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提供者激励措施对苏格兰 NHS 牙科 X 光检查的影响：如果患者更换提供者会发生什么？

背景

在许多市场环境中，鼓励个人更换医疗保健提供者以确保更多竞争。转换可能具有增加不必要治疗的潜在不良副作用。重点关注最常见的医疗辐射源（牙科 X 射线），本研究的目的是评估在更换牙医后，X 射线暴露是否会根据提供者付款的类型而增加。

方法

该分析使用了 2005 年至 2016 年的纵向数据，涵盖了国家卫生服务 (NHS) 覆盖的苏格兰成年人口的 5% 随机样本。采用多重固定效应面板回归分析来确定提供者薪酬与患者在其他条件相同的情况下切换到新牙医时接受 X 射线的可能性之间的相关性。控制了一组广泛的协变量，包括患者的共付额状态。

结果

在转为按服务付费的牙医后，与转为受薪牙医相比，患者接受 X 光检查的概率高 9.6%（95% CI 7.4–11.8%）。在考虑患者豁免状态以及未观察到的患者和牙医特征时，结果是稳健的。

结论

与留在同一位牙医处相比，患者在切换到按服务付费的牙医时可能会接触到更多的 X 射线。可能需要更好的指导和监管来保护那些因搬家而不得不更换提供者的人的健康，并在提倡自愿更换时更加谨慎。